Misuse of opioid agonists in patients admitted for detoxification during the SARS Cov 2 pandemic

Background

Opioid use disorder is a global public health problem and represents a major cause of overdose deaths. Opioid agonists are considered the most effective pharmacological intervention in the treatment of opioid dependence. The management of therapeutic programs with agonists varies widely between units, with important differences concerning the prescribed dose, the duration of treatment and the conditions for accessing the programs.

During the SARS Cov-2 pandemic, it was necessary to adapt the units' operating models, with possible consequences for users' consumption patterns.

Aims

·         To characterize the risk profile for misuse in patients undergoing treatment with opioid agonists during the SARS Cov-2 pandemic

·         To analyze the influence of the pandemic on therapeutic compliance in patients being treated with opioid agonists

Methods

This was an exploratory, descriptive-correlational and cross-sectional study, which included a total of 242 patients admitted to the Coimbra Detoxification between March of 2019 and October of 2020. Patients were divided in two groups: the first group included patients admitted to treatment in the pre-pandemic period and the other patients treated between October of 2020 and October of 2021 (pandemic crisis).

Results

In the analysis of the groups in relation to the variables under study, a statistically significant association was observed in relation to gender (x2(1)=6,549; p=0,010) and polyconsumption (x2(1)=4,077; p=0,043).

There was an increase in the misuse of opioid agonists among patients hospitalized during the pandemic (x2(1)=4,118; p=0,042)

This was more evident in the case of buprenorphine compared to methadone programs. It is important to note that prolonged-release formulations of buprenorphine are not yet available in Portugal.

Conclusion

It’s important to critically reflect on the best treatment model for patients with opioid use disorders during crisis situations like SARS Cov-2 pandemis, ensuring flexibility, safety and quality of care, and minimizing the misuse of opioid agonists and the associated risks, particularly deaths from overdose.